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Impaired Self-Awareness After Acquired Brain Injury: Clinicians' Ratings on Its Assessment and Importance for Rehabilitation

Winkens, Ieke PhD; Van Heugten, Caroline M. PhD; Visser-Meily, Johanna M. A. PhD; Boosman, Hileen MSc

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: March/April 2014 - Volume 29 - Issue 2 - p 153–156
doi: 10.1097/HTR.0b013e31827d1500
Original Articles

Background: Impaired self-awareness is a potential obstacle to successful rehabilitation.

Objective: To obtain clinicians' ratings of the importance of self-awareness for brain injury rehabilitation and use of instruments to assess self-awareness.

Participants: One hundred sixty-three members of 3 major Dutch organizations for neuropsychology or rehabilitation.

Main Measure: Online survey addressing: (1) factors participants consider important for the course and success of rehabilitation, (2) whether they assess patients' levels of self-awareness, and (3) the instruments they use to do so.

Results: Of the 163 respondents, 116 (71.2%) considered self-awareness to be important for the course of rehabilitation; 113 (69.3%) considered it to be important for the success of rehabilitation. One hundred fifty-six clinicians (95.7%) reported assessing patients' levels of self-awareness, but only 12 (7.4%) reported using standardized instruments specifically designed for this purpose. The instruments most frequently reported to be used were the Awareness Questionnaire and Patient Competency Rating Scale.

Conclusions: It is difficult to capture different aspects of self-awareness in a standardized manner. There is a need for instruments that are valid and reliable and that have good clinical utility.

Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (Drs Winkens and Van Heugten), and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (Dr Van Heugten), Maastricht University, Maastricht; and Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat, Utrecht (Dr Visser-Meily and Ms Boosman), the Netherlands.

Corresponding Author: Ieke Winkens, PhD, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands (

This study was supported by the Netherlands Organisation for Scientific Research (Nederlandse Organisatie voor Wetenschappelijk Onderzoek, NWO, grant no. 056-11-013).

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins